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Order Number:SAP EC Notification Number: <br />1 SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />f|| Electric Corrective <br />M|V 1 Work Form <br />iTnBN OVERHEAD <br />"FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Facility:Damage: <br />*- s <br />Action: <br />'PRIORITY <br />D A - Emergency <br />El B - Urgent <br />D E; 12 Months <br />0T-REG - Next Insp <br />"•Reporting Information: <br />'Identified in Field By: (PG&E = LAN ID) <br />*LAN ID <br />'Identified in Field On: <br />'Recommended Repair Date <br />/ ff t /J <br />MM DD YY <br />?/ /** //; <br />MM DD YY <br />Work Type Code: <br />'E Crew Size <br />Efe: <br />•GC rew S/ze <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clerical if unknown in field) <br />'Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />'Plat Map: <br />ttb<J <br />'Circuit: <br />'llcOD^-l 1 O 1 <br />'SSD: <br />a-MlS" <br />Pole # (Required if numbered Pole)Equipment #: <br />lO2cfo£>3- <br />Meter #: <br />% <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'L ocation /: 'Street A ddress:Cross Street: <br />"Main Workcenter:Latitude / Longitude: <br />f <br />'Identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply); <br />Buompliance Inspection D Trouble-Work D Equipmeni Inspection D Joint Pole D Customer D Substation D PG&E/QA Audit <br />D Compliance Patrol D Crew-Work D Pole Test & Treat P Other Q UWF (Urban Wildfire Area) D Work Verification D CPUC Audit <br />D Infrared (Check only if attaching IR Data Sheet) D SmartMeter™ <br />'Conductor Type (Required - Check One): <br />LJ Primary D Secondary D Service D Service / Streetlight Conductor <br />ERR P\n (Reference Only) D PIN#: <br />OIS: (Required if Outage Related) D OIS #: <br />Field Condition - Exposure (Check all that apply - provide supporting comments if addition information is needed for field); <br />D High Public Exposure OR Public Gathering Area (school, park, mall, etc.) D Commercial / Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area S^Remote (Ag or Low Populated Area, etc.) D Waterway <br />Field Condition - Accessibility (Check all that apply - provide supporting comments if addition information is needed for field): <br />D No Road Access D Seasonal Work: (Dry, Harvest, Snow, etc.) Cannot Work From __ __/__ _ To ._ / <br />D Traffic Control Plan Required MM / DD MM / DD <br />D Customer Issue (will not allow PG&E on property, etc.) D City Moratorium: Cannot Work From /__ To /_ <br />D CGI (Can't Get In): Dog, Locked Gate, Etc. MM/ DD MM/ DD <br />D Rear Easement D Special Circumstances: <br />'Is a Clearance required? D Yes D No Q'unknown 0*^TA/LTA D Flagging Required? DUSA Required? <br />*F/e/d Comments (Describe the work required and the equipment and materials needed. For example: Special tools or equipment, any unusual conditions, <br />special circumstances, and supporting comments related to Exposure or Accessibility): <br />Digital Picture #: <br />Bird Report Event Log #:'Bin! Incident No.: (Required for BGR/57R Raptor Work): <br />SECTION 2 - TO BE COMPLETED BY CREW PERSONNEL IF WORK IS COMPLETED IN FIELD (EMERGENCY OR SAME-DAY): <br />Completed By (LAN ID): <br />Signature: <br />Completed by T-Man? <br />/ verify that all maintenance on this notification is completed <br />Completed On: <br />M <br />*Reviewed By: L <br />Actual Labor Hours: <br />DD YY <br />Compliance Department Review <br />'Reviewed On:I I <br />Version 1.6, Effective 6/26/2012